The personal touch of the family doctor, crucial for the overall well-being of a patient, now belongs to another era. The advent of corporate, multi-brand hospitals has led to the slow demise of neighbourhood nursing homes, and more importantly, the General Physician.
While the government is promoting Public Health Centres (PHCs) and Namma Clinics on the lines of mohalla clinics to improve medical care, it has been able to do little to control the closure of nursing homes. Doctors blame the lengthy and costly legal establishment procedures, lack of trained nurses and availability of space as the main reasons.
Doctors also state that in family setups, the younger generation does not want to continue with parents’ clinics, but work with big brands for better recognition and professional success. Rising competition and the corporate setup of large hospitals are leading to the death of clinics, they add.
This is the era where treatment has become an investigation. Nowadays, patients are not content if the doctor does not prescribe a blood test or CT scan, nor are doctors happy to prescribe simple medicines and give a word of good advice, admitted Dr Vivek Dorai, Deputy Director (medical-2), Karnataka Private Medical Establishments (KPME).
According to KPME, there are 30,000 private medical establishments in the state, across 18 categories, apart from large corporate and super speciality hospitals. A senior health department official admitted: “There is no ready availability of data of how many have shut down in the past five years. It is unfortunate but true, that corporate hospitals have become the trend.”
Dr Kanchi Pralhad V, Vice-President, Karnataka Medical Council, recollected that he had set up his clinic with Rs 6,000, around 30 years ago. But now, after investing lakhs of rupees, even if a doctor gets 20 patients a day, it is not viable. Despite the growth in large hospitals, patients still trust neighbourhood doctors.
UDUPI: End of a relationship
The emergence of the corporate model of hospitals in the last decade has significantly changed the doctor-patient relationship, noted Dr M V Holla, a family physician practising in Manuru-Kota. With some corporate hospitals opening rural franchises and treatment covered by insurance policies, patients too have adjusted to the new model, but this model has negatively impacted the traditional relationship, he said. ‘‘Everything seems to be business, and unhealthy competition has put the interest of patients on the back seat,’’ he added. General practitioners have been reduced to counsellors, with patients availing of treatment at big hospitals, he said.
GADAG: Small clinics preferred
In Gadag, the situation is very different. Here, Bachelors of Ayurvedic Medicine and Surgery (BAMS) doctors are attracting more footfall as people prefer small clinics after the pandemic. MBBS and MD qualified professionals are also successful. Some private doctors recently urged the Gadag Institute of Medical Sciences to shift the Women and Children Hospital 8km away from the city, as it was affecting their business.
Paediatricians, neonatologists, ophthalmologists and others are running their own hospitals, besides working as consultants at some hospitals. Residents say that doctors in private hospitals charge hefty fees. Last month, the health department also issued a notice on this.
HASSAN: Healthcare hub
Hassan city has become a medical hub with 15 private hospitals running in different areas, and doctors are constantly searching for land to construct nursing homes. Apart from a super speciality hospital coming up at the premises of Hassan Institute of Medical Sciences, six general practitioners closed their clinics due to a lack of patients in the past five years. At least nine physicians stopped practising and joined private hospitals in the last decade.
In the changed scenario, patients want hi-tech facilities and treatment at prominent private hospitals. Siddaraju, who was admitted to a private hospital for stomachache and discharged recently, said doctors recommended different types of tests after admission, which is a burden for patients.
KOLAR: Docs looking for big salary
Senior physician Dr Dias said people expect good service and demand more facilities but at a low cost. Nowadays, those who complete MBBS choose MD and MS, or any specialised course by paying a big fee, and have no alternative but to work in corporate hospitals for a substantial salary, said Dr Dias, who has 30 years of experience. In the evenings, they prefer to practice in hospitals as consultants, which is why corporate hospitals are popular. Earlier, family physicians would visit patients’ houses on request, now the system has changed, said K Jayaraman, a businessman.
SHIVAMOGGA: Status quo
The district has not seen any significant number in increase or decrease in nursing homes in the past five years. District Health Officer Dr Rajesh Suragihalli said the number of private and small clinics has increased. “The clinics include allopathy and Ayurveda. It is also a fact that small nursing homes and clinics do not have the capital to compete with corporate hospitals,” he said. The public feels that medical costs have increased.
KALABURAGI: Where GPs thrive
There is no threat to neighbourhood nursing homes and general practitioners in the Kalyana Karnataka region, with at least one GP at every kilometre in Kalaburagi city. The main problem exists in rural areas, where doctors hesitate to open clinics. People still depend on GPs for common diseases, and if the matter turns serious, they refer patients to corporate hospitals.
A district surgeon of Gulbarga Government Hospital denies that the number of patients opting for treatment in government hospitals has declined due to corporate hospitals. District Surgeon Dr AM Rudrawadi said after the Ayushman Bharat Scheme came into existence, the number of patients in government hospitals increased.
CHITRADURGA/ DAVANAGERE: Few clinics here
There are few neighbourhood clinics, barring a few old medical practitioners who are Registered Medical Practitioners, in Chitradurga and Davangere. Dr Kantharaj, an octogenarian practitioner in Chitradurga, said the abolition of the Medical Council of India and the formation of the National Medical Commission led to these problems. “Corporatisation of healthcare has led to the closure of small clinics. The KPME has become draconian for small-time practitioners. They have to follow biomedical waste management, set up bathrooms, and provide spacious rooms and other facilities which are not available in small clinics. The government is also giving support to corporates,” he said.
MANGALURU: Future in corporate hospitals
Since the 90s, following the privatisation of healthcare and higher education, everything has changed. The quality of medical education has nosedived, graduates are not interested in returning to mofussil areas, and postgraduation has become the norm. There is hype about super-speciality treatment and the corporatisation of healthcare. Corporate hospitals are getting many facilities. The future of health seems to be in corporate hospitals engaging AYUSH trainees to manage villages through telemedicine, said Dr Srinivas Kakkilaya, a senior physician.
Nursing homes have not aligned to the changing times, nor do outreach work to support the community. The nursing home model is dying due to changing times, said Dr Edmond Fernandes, Director, Edward & Cynthia Institute of Public Health, Mangaluru.
DHARWAD: Giant hospitals fashionable
The concept and projects of the government are only for gaining popularity. These days, it has become a trend for young doctors to construct giant hospitals. This has impacted clinics in small areas, which catered to people for many years. Large hospitals hire doctors catering to small areas to manage the rush. Patients who would get treatment at local hospitals at a minimum cost now have to pay huge amounts at nursing homes. The popularity, advertisements and other activities force hospital authorities to charge more to level their expenses. While there is no notable decline in clinics, doctors frequently change as they get better offers from private hospitals.
(Inputs from Bosky Khanna, Namrata Sindhwani/Bengaluru, Prakash Samaga/Udupi, Raghu Koppar/ Gadag, Udaya Kumar/ Hassan, Velayudham/ Kolar, Marx Tejaswi/ Shivamogga, Ramkrishna Badseshi/ Kalaburagi, G Subash Chandra/ Chitradurga/ Davangere, Divya Cutinho/ Mangaluru, Mallikarjun Hiremath/ Dharwad)